Healthy Learners Asthma Initiative (HLAI)

The Health Learners Asthma
Initiative (HLAI) is a collaboration aimed at improving asthma care in schools.
In a random assignment study, students in schools assigned to implement the
program were compared with students in schools assigned to a standard- care
control group. The students in the intervention group visited the school health
office significantly less often than did students in the control schools. The
intervention schools also had asthma medication that was more accessible, and
more students with asthma action plans. Additionally, intervention schools
reported more peakflow measurements, asthma instruction, and contact with
parents. Clinics implementing the HLAI created and sent more asthma action
plans to a central office. The differences in attendance between control and
intervention schools were significant only for those students who received care
in the school health office.

DESCRIPTION OF PROGRAM

Target population: Students
with moderate/severe asthma and/or poorly controlled asthma (defined as visiting
health office for asthma more than once a week).

The HLAI has three different components. First, the Health Related Services
Director oversees the program and its implementation, including communicating
with other partners, developing evidence-based practice protocols, and
coordinating staff trainings.Trainings
begin with a half-day introductory session that is enhanced with quarterly
trainings on various asthma topics. Second, asthma resource nurses visit
schools once or twice a month in order to provide coaching to licensed school
nurses, licensed practical nurses, and health service assistants. The staff
uses the “Core Components of Asthma Management in the School Health Office”
guidelines in providing care to students with poorly controlled asthma. Last,
training is provided to clinic staff on understanding and applying NIH
guidelines for asthma care. The main goals of the program are to strengthen
asthma management and decrease health problems related to asthma in school
children, such as absences from school and hospitalizations.

Evaluated population:
Sixteen Minneapolis public schoolsconstituted this sample. The
researchers used school health office records in order to identify students with
asthma. The intervention schools had 916 students with asthma, while the
control schools had 645 students with asthma. Overall, 58 percent of the
students that had asthma were male, and 73 percent were considered eligible for
free/reduced-lunch prices. The sample of students with asthma consisted of 66
percent African-American, 6 percent Hispanic, 5 percent American Indian, 3
percent Asian, and 20 percent white students. In the intervention group,
students were 71 percent African-American and 16 percent white; and there was a
higher proportion eligible for free or reduced-price lunches (76% versus 67% in
the control group). In the control group, students were 60 percent
African-American and 27 percent white.

Approach: The schools wererandomly assigned to either the intervention or the control group. Schools
were matched for race/ethnicity, grade levels, percentage of students eligible
for free or reduced-lunch, attendance rates, and student turnover rates. Intervention
schools implemented the enhanced asthma management program of the HLAI, and
control schools maintained their normal procedures for asthma care. The
researchers measured impacts on the performance of the school health offices as
well as on students’ school attendance. Additionally, seven clinics that
provided health care to students with asthma were invited to participate in
performance improvement projects.

Health office records from February
to June 2001 were used to measure differences in the number and quality of
students’ asthma-related visits. Researchers observed clinics’ progress each
month on the implementation of their process improvement plan. School attendance
records from 1999-2000 and 2000-2001 were used to calculate the percentage of
days attended for each student.

Asthma management activities in the
schools were monitored in October, February, and April to measure
sustainability. Other data collected included numbers of episodic asthma visits
(visits due to asthma symptoms), medications administered, and parent and health
care provider communication.

Results: The intervention
had an impact on total asthma visits and episodic visits, with significantly
more visits reported in control schools than in intervention schools. The
proportion of visits that were episodic was significantly higher in control
schools than in intervention schools. The intervention had significant impacts
on asthma care activities: parents in intervention schools were contacted more
frequently regarding episodic visits; intervention schools obtained peakflow
measurements on more students ; they had more students getting asthma
instruction and action plans and they had better access to asthma medications.

There were no significant
differences in school attendance between control and intervention groups, or
between students with asthma versus students without.